Healthcare organizations across the United States all face a common dilemma of needing to constantly find ways to improve the health of their patient populations – not only for those patients' well-being, but also to improve their own financial health.

The key is to improve health status without breaking the bank – and that is especially important for the nation's more than 1,350 critical access hospitals, most with around 25 beds, that serve rural areas.

During the coronavirus pandemic, with small and rural hospitals having to cut costs even as they gird for an increase in COVID-19 patients, meeting that imperative is more challenging than ever.

These hospitals are not just care centers, but commonly serve as the hub of the community, says John Gale, a senior research associate at the Maine Rural Health Research Center at the University of Southern Maine in Portland.

"For more than 20 years we have worked with small hospitals and clinics to help them think about how to build their missions," said Gale.

The hospitals worry about healthcare disparities, but aren't sure how to fix them. Some are turning to adopt social determinants of health with help from Maine Rural Health.

Researchers are focusing on festering barriers that include access to insurance, shortages of primary care physicians, long-term care, mental health services, addiction specialists and sustaining services. Yet, more barriers loom for rural providers, Gale said.

"Health organizations want to adopt use of social determinants of health to see the big picture of disparities, but it is scary to get into social determinants when you are scared about how to keep the doors open."

That's why it is so important for rural providers to branch out and take advantage of opportunities already awaiting them in the community, Gale contends. For example, providers could connect with restaurants and bars to tighten the communities' liquor laws.

To further improve health status in rural areas, providers can use the data in their electronic health record to create a registry that can identify and track patients with diabetes, hypertension, abuse issues and depression, and create a chronic-care-management program that also gives the organization increased reimbursement for providing higher levels of care and improved health status in the community.

Telehealth is another tool a community can consider, even if the use of telemedicine consultations do not result in reimbursement to providers, since health organizations would still have a better understanding of their patients and be more able to better know their needs.

Obviously, reimbursement of telehealth services by the Centers for Medicare and Medicaid Services or other entities would be optimal. This, however, requires changes in clinical practice, and an organization may not have access to various telehealth specialists, John Gale notes.

That said, the COVID crisis could spur a significant need for telehealth services as COVID will impel more use of telehealth to keep everyone further apart from each other.

"The big barrier has been that patients often have needed to be in a medical site to receive care," Gale explains. "Now, we want people apart and can use telehealth to see patients without being with each other. This is clearly a population-health-management opportunity that will change medicine and change our thinking in a very significant way."

Email the writer: joe_goedert@yahoo.com
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